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About the series
In the weeks since the Omicron variant of COVID-19 was first identified, we are beginning to gain a better understanding of the new variant. However, there remains a great deal of uncertainty and unknowns, so many employers are being flexible in regard to reopening offices – especially as Delta also remains a threat.
Transmissibility: It seems clear that the Omicron variant is more transmissible than the Delta variant, which was more transmissible than previous strains of SARS CoV2 – the virus which causes COVID-19. Since its discovery in mid-November, Omicron is already the dominant variant in South Africa, and some have suggested that it might be twice as contagious as the Delta variant. We’ve seen reports of superspreader events in vaccinated individuals from Norway, Denmark and the U.K., as well as a remarkable transmission across a hallway in a Hong Kong quarantine hotel.
Ability to evade vaccines: The limited data we have so far suggests that vaccines continue to provide important protection against hospitalization and death from Omicron infections. We’ve seen a spate of reports of a decrease in neutralizing antibodies with Omicron. These and the sheer number of mutations on the virus’ spike protein make many experts believe that vaccines or immunity from previous infection will be less effective at preventing new COVID-19 cases due to Omicron. But these lab tests don’t give any indication of how T-cells will respond.
It’s likely that vaccination, especially with a booster, will continue to offer good protection against hospitalization and death from COVID-19. Pfizer data suggest that, with a booster, its vaccine might be as effective with Omicron as two doses are with the Delta variant.
Testing: Currently available antigen and PCR tests can detect the Omicron variant.
Severity: There are early reports from South Africa that suggest Omicron will lead to less severe infections than the Delta variant, but it is too soon to draw this conclusion. Most reported infections so far have been in younger patients who were less likely to have severe complications.
If the Omicron variant is more transmissible, it could lead to a large spike in cases and could overwhelm hospital capacity even if, on average, those who get this variant are less sick. If Omicron is better able to infect those with previous immunity, this could lead to a large number of mild infections without a decrease in severe infections. As a result, we should keep our eyes on total hospitalizations rather than the portion of infections that lead to hospitalizations.
Implications for employers:
Federal courts have paused all three federal regulations requiring employee vaccine mandates for federal contractors, hospitals and nursing homes, and employers with over 100 employees. Various appeals courts will hear arguments about whether these mandates can go forward, and the Supreme Court may ultimately decide their legality. In the meantime, several federal agencies have announced that they will not enforce the requirements for employer vaccine mandates pending court decisions.
Regardless, vaccines continue to be very effective. People who are vaccinated fully are five times less likely to get COVID-19, 12 times less likely to be hospitalized and 13 times less likely to die. Boosters help, too. Those who had boosters in Israel had 90% fewer cases and 90% lower mortality from COVID-19 compared to those who had just two mRNA shots. Residents of nursing homes in the bottom quartile of staff vaccination were over two times more likely to get COVID-19 and almost three times more likely to die of COVID-19 than residents of nursing homes in the top quartile of staff vaccination rate.
The evidence that vaccine mandates increase vaccine uptake is strong, but 14 states have laws prohibiting vaccine mandates, and, as of now, there is no federal regulation to preempt state bans. Therefore, employers that decide to proceed with a vaccine mandate will generally not include employees in these states.
What can employers do?
The Food and Drug Administration and the CDC approved Pfizer boosters for those age 16 and 17 years old on December 9, 2021 – recognizing the importance of boosters as we face the more infectious Omicron variant. This can help make high schools, families and communities safer over the winter.
The New England Journal of Medicine also published research showing that those who got booster shots (Pfizer) had a 10-fold lower risk of death compared to those who had just two shots. This was a large observational study (over 800,000 people).
In light of the growing research, some public health experts advocate changing the definition of fully vaccinated and suggest that people need three shots (mRNA) or two shots (J&J) to be protected from COVID-19. The threat of the Omicron variant makes boosters even more important. However, the CDC continues to consider two shots (Pfizer or Moderna) or a single shot (J&J) to represent full vaccination.
Implications for employers:
Infection, hospitalization and death rates have increased in the U.S. since the Thanksgiving holiday. This is partially due to uneven reporting. Florida, for instance, didn’t issue any reports during the holiday week. But the higher rates are mostly due to a real increase in infection rates, and these infections are almost universally still the Delta variant.
Hospitals are so badly stretched that the National Guard was called up in four states (New Hampshire, New York, Indiana and Maine). A recent CDC report confirmed that when hospitals have ICU bed shortages, the excess death rate from non-COVID-19 disease goes up, so the pandemic can cause increased risks even for those who are not infected.
Source: CDC, December 10, 2021
Vaccination rates have also increased. We are up to almost 2 million doses daily. Seventy-one percent of the population has had at least a single shot, 60.5% are fully vaccinated, but only 25% of those who are fully vaccinated have had boosters so far.
People missed their holiday parties in 2020 due to the pandemic, and many employees are looking forward to holiday parties this month. The increase in Delta infections since November and the specter of Omicron has made some companies postpone holiday parties – especially since the weather in much of the country is inhospitable to outdoor events. Not having an in-person gathering is the best way to ensure the safety of employees.
For companies that still have parties despite widespread community transmission throughout the U.S., there are some actions they can take to reduce the risk of a holiday party becoming a superspreader event.
It’s clear that even when precautions are taken, attendees can be infected with COVID-19, particularly as Omicron increases. The Omicron superspreader event in Norway required all participants to be vaccinated and to have an antigen test the day of the event. Despite that, over 70 of the 150 attendees were infected with Omicron.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
